Catatonia in patients with anti‐NMDA receptor encephalitis

Abstract

Aim There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti‐NMDA receptor encephalitis (ANMDARE). This study aimed to measure the frequency of catatonia in this condition and to delineate its particular symptoms. Methods A prospective study was done with all inpatients who fulfilled the criteria of definite ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico from January 2014 to September 2018. The Bush–Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission. Results Fifty‐eight patients were included and catatonia was diagnosed in 41 of these patients (70.6%). Immobility, staring, mutism, and posturing were the most frequent catatonic signs. Catatonia was associated with delirium, hallucinations, psychomotor agitation, generalized electroencephalography dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample; it was associated with status epilepticus, and was less frequent in the catatonia group. After immunotherapy, all cases showed a complete recovery from catatonic signs. Conclusion This systematic assessment of catatonic syndrome shows that it is a frequent feature in patients with ANMDARE as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia with schizophrenia and affective disorders.

Catatonic features in children and adolescents with N-methyl-d-aspartate receptor antibody encephalitis

“…In total, 86% of children and adolescents with NMDARE had signs and symptoms consistent with catatonia, in keeping with previous reports of catatonia in 19-88% of NMDARE patients. 4,6,7 The symptomatology was complex, with 69% of affected patients manifesting both positive (hyperkinetic) and negative (hypokinetic) features. Only 33% were recognised as catatonic by the reporting physician.…”

“…This is consistent with findings in adults with NMDARE, in which both status epilepticus and death occurred more often in patients without catatonia. 6 Recent research implicates dysregulation and hyperactivity of the cortical supplementary and presupplementary motor areas as a pathophysiological mechanism in catatonia; 9 it may be that patients who are more severely encephalopathic (who tend to have worse outcome) are unable to support any organised output of cortical motor circuits, and so are unable to manifest the behavioural signs of catatonia.…”

COVID-19 Catatonia—Would We Even Know?

“…The work offered the first description of anti-NMDA receptor encephalitis ( 6 )—which is now recognized as the most common form of autoimmune encephalitis. Moreover, the link to catatonia—and, thereby, the role of glutamatergic signaling—is clear and consistent: 70.6% of these patients have catatonia ( 7 ).…”

Neurocritical care for Anti-NMDA receptor encephalitis

“…Catatonia, a neuropsychiatric syndrome involving a combination of mental, motor, speech, vegetative, and behavioral signs, has been increasingly reported to be a part of the clinical presentation of anti-NMDA receptor encephalitis [ 47 , 48 ]. The most common presenting signs are immobility (motor inhibition), staring, mutism, posturing, withdrawal, and rigidity [ 47 ].…”